Provider Demographics
NPI:1831338102
Name:GARDNER, SUSAN MCMAHON (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MCMAHON
Last Name:GARDNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUSAN
Mailing Address - Street 1:410 ROUTE 10
Mailing Address - Street 2:SUITE 202 WEST TEN PLAZA
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852
Mailing Address - Country:US
Mailing Address - Phone:973-584-2020
Mailing Address - Fax:
Practice Address - Street 1:410 ROUTE 10
Practice Address - Street 2:SUITE 202 WEST TEN PLAZA
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852
Practice Address - Country:US
Practice Address - Phone:973-584-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00481600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist